If you are injured on the job or diagnosed with an occupational disease, it is important that you follow these instructions to ensure that any immediate health or safety related risks are addressed.
YOUR RESPONSIBILITIES IF YOU'RE INJURED AT WORK
1. Inform your supervisor
All on-the-job injuries are to be to your supervisor or their designee immediately.
2. Complete an employee incident report
Not all incidents become claims or require additional follow-up, but all employee incidents need to be recorded to retain the facts of the injury and to gather information for loss prevention purposes. Complete the employee's portion of the Employee Incident Report form and give it to your supervisor for completion. It is important that you retain a copy for your records.
Note: If your injury involved a bite, needle stick or other possible exposure to blood or other potentially infectious materials, please also review and complete the Bloodborne Pathogen Exposure Report.
3. Submit Report(s) to the district office
Send the completed paperwork to firstname.lastname@example.org or to the district's Safety/Risk Manager at the District Office.
IF YOU DO NOT NEED MEDICAL TREATMENT AT THIS TIME, STOP HERE. If you later need to see a health care provider, please follow the steps below.
WHAT TO DO IF YOU NEED TO SEEK MEDICAL ATTENTION
As an employee, you have the right to file a workers’ compensation claim (claim) for on-the-job injuries. If certain criteria are met and the claim is accepted, the claim will provide coverage for specific expenses related to your injury.
1. Contact ESD 112 Workers' Compensation Claims Department at 1-800-749-5861
Unless immediate emergency medical care is required, contact ESD 112 BEFORE going to the doctor, to obtain a claim number.
2. Select a health care provider who is qualified to treat your injury
For your initial visit, you may select any health care provider who is qualified to treat your injury. If you require medical care after the initial visit, you will be required to choose a health care provider from within the State's approved provider network. You may search the approved provider network at: https://www.lni.wa.gov/claims/for-workers/find-a-doctor/.
Regardless of who you choose to see for your first visit, it is strongly recommended to call in advance to ensure that the provider is willing and able to provide treatment.
The following medical facilities regularly provide care for occupational injuries in our area and do not require an advance appointment, but do request a phone call prior to your visit:
- Health First Urgent Care (509) 300-1500; 37 Columbia Point Dr; Richland, WA 99352
- Physician's Immediate Care (509) 946-7646; 550 Gage Blvd; Richland, WA 99352
- Physician's Immediate Care (509) 946-7646; 310 Torbett St; Richland, WA 99354
- Tri-Cities Community Health (509) 547-2204; 515 W Court St.; Pasco, WA 99301
- Lourdes Urgent Care (509) 543-9300; 5304 N Rd 68; Pasco, WA 99301
- Lourdes Occupational Health Center (509) 546-2222; 9915 Sandifur Parkway; Pasco, WA 99301
- Lourdes Occupational Health Center (509) 221-6770; 7201 W Grandridge Blvd; Kennewick, WA 99336
3. What you need to tell the medical provider
Please remember to tell the medical provider you select that you are treating for a work-related incident and that the district is self-insured as a member of the SE WA Workers' Compensation Trust and provide them your claim number.
4. What to do BEFORE you see the medical provider
A Provider's Initial Report (PIR) should be completed with the medical provider during your FIRST appointment. It is extremely helpful for you to print the PIR and complete the "patient information" section (items 2-15) in advance of your appointment and take it with you to the doctor. Most health care providers have blank copies of this form their office, but having the form completed in advance with our insurance information prepopulated will expedite your visit and ensure proper handling of your claim. Be sure to complete every applicable field and sign both employee signature lines (items 14 & 15).
5. What to do AFTER each medical provider visit
Contact your supervisor following each visit to provide an update on your return to work status.
Within one business day of each visit (related to the claim), a copy of paperwork from the health care provider should be sent to email@example.com or to the district's Safety/Risk Manager at the District Office.
Contact Aubrey Pitzer, Safety/Risk Manager - firstname.lastname@example.org - (509) 543-6700 ext. 2349
Page Last Updated: 03/06/2020